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Review
. 2015 Jan;122(1):4-23.
doi: 10.3171/2014.7.JNS131644.

Meningiomas: knowledge base, treatment outcomes, and uncertainties. A RANO review

Leland Rogers  1 , Igor Barani, Marc Chamberlain, Thomas J Kaley, Michael McDermott, Jeffrey Raizer, David Schiff, Damien C Weber, Patrick Y Wen, Michael A Vogelbaum
Affiliations
Review

Meningiomas: knowledge base, treatment outcomes, and uncertainties. A RANO review

Leland Rogers et al. J Neurosurg. 2015 Jan.

Abstract

Evolving interest in meningioma, the most common primary brain tumor, has refined contemporary management of these tumors. Problematic, however, is the paucity of prospective clinical trials that provide an evidence-based algorithm for managing meningioma. This review summarizes the published literature regarding the treatment of newly diagnosed and recurrent meningioma, with an emphasis on outcomes stratified by WHO tumor grade. Specifically, this review focuses on patient outcomes following treatment (either adjuvant or at recurrence) with surgery or radiation therapy inclusive of radiosurgery and fractionated radiation therapy. Phase II trials for patients with meningioma have recently completed accrual within the Radiation Therapy Oncology Group and the European Organisation for Research and Treatment of Cancer consortia, and Phase III studies are being developed. However, at present, there are no completed prospective, randomized trials assessing the role of either surgery or radiation therapy. Successful completion of future studies will require a multidisciplinary effort, dissemination of the current knowledge base, improved implementation of WHO grading criteria, standardization of response criteria and other outcome end points, and concerted efforts to address weaknesses in present treatment paradigms, particularly for patients with progressive or recurrent low-grade meningioma or with high-grade meningioma. In parallel efforts, Response Assessment in Neuro-Oncology (RANO) subcommittees are developing a paper on systemic therapies for meningioma and a separate article proposing standardized end point and response criteria for meningioma.

Keywords: CGE = cobalt gray equivalent; EBRT = external beam radiation therapy; EORTC = European Organisation for Research and Treatment of Cancer; GTR = gross-total resection; MEN1 = multiple endocrine neoplasia Type 1; NF2 = neurofibromatosis Type 2; PFS = progression-free survival; RANO = Response Assessment in Neuro-Oncology; RTOG = Radiation Therapy Oncology Group; SRS = stereotactic radiosurgery; STR = subtotal resection; meningioma; oncology; outcomes; radiotherapy; surgery.

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Conflict of interest statement

– The authors report no conflicts of interest concerning the materials or methods used in this study or the findings specified in this paper, with the exception of: Leland Rogers: Principle Investigator for a research grant from the National Cancer Institute in support of the clinical trial RTOG 0539 Igor Barani: BrainLab Research Grant & NAGKC Research Grant

Figures

Figure 1
Figure 1
Recurrence-free (a) and overall (b) survival for 643 patients with meningioma stratified by WHO grade. Among the 643 patients studied, 464 (72.2%) had a grade I meningioma, 156 (24.3%) grade II, and 23 (3.5%) grade III].
Figure 2
Figure 2
Pre-operative (2a) and post-operative (2b) MRIs as well as the dosimetry plan CT (2c) for EBRT on a patient with a subtotally resected WHO grade I meningioma. The prescription dose is 5400 cGy in 30 fractions (180 cGy per fraction). Courtesy of Heyoung McBride, MD and Terry Thomas, MS, Barrow Neurological Institute, Phoenix, AZ.
See this image and copyright information in PMC

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